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Nothing at the pump

Hello,
I want to start with full disclosure here: I'm not a mother (hope that doesn't complicate things! ). I'm a father of a 3 mo and we've been having BF problems since day one, but for now I'll just ask about pumping.

After the first couple of weeks of struggling with whether to continue BF or not, we decided to stick with it and bought an Ameda Purely Yours to increase supply (major weight loss after leaving hospital required supplementation: her milk was mostly colostrum until about the 2 week mark). For the last couple of weeks she has either been pumping or manually expressing (if the pump cups are still drying) after every feed.

The question is: Is only getting a few drops (literally) after 10 minutes of pumping after a feed normal? I think the most she's ever pumped/expressed after a feed is maybe 5 ml, and we know it's hindmilk because it's like half and half when we store it. It really discourages her when she sees this every time. She has never been great at the pump. The most she's ever pumped between feeds has been ~40 ml (both breasts together) and that was 3 hours after a feeding. She reads about people pumping 3-4 oz. a time and that also gets her fairly discouraged.

Re: Nothing at the pump

Welcome to the forum!

Yes, it's totally normal for post-feeding pump output to be very scanty, provided that the baby is nursing well, gaining adequate weight, and producing the appropriate amount of wet and poopy diapers. When a mom's milk supply is well-matched to baby's demand, there isn't a lot of extra milk to pump out.

One issue here could be the pump. The APY is a decent pump. It's best for a working mom with an established supply who responds well to pumping. But when a mom wants to increase supply, the APY isn't the right tool for the job. You want a more powerful machine- think hospital-grade rental or at least Medela Pump in Style, with correctly sized shields to ensure maximum stimulation and milk removal.

Have you been supplementing at all? If so, let us know because that will affect the advice we give you.

Just FYI: it's normal for milk to contain an admixture of colostrum for several weeks after it comes in. This "transitional" milk will appear yellowish white or cream-colored, but will be translucent and not transparent. If your wife truly had only colostrum for 2 weeks, then she should discuss it with her doctor or midwife, because it implies that there may have been some sort of physical impediment to milk production, like a retained placenta fragment, or perhaps formula supplementation delayed the onset of milk production well beyond average.

Re: Nothing at the pump

Guess it's time to write the novel.

The BF issues started the second night. She wanted to eat all night and it was really painful due to improper latch. By the time we talked to the lactation nurse the next day the damage was done. Even when she claimed the latch was perfect, mom complained of pain. We got a few more pointers and were told the pain should subside. Not only did it not subside, when we went in for her next checkup, she had lost even more weight than when she was released. Concerned about weight gain, the LC gave us a SNS and told us to supplement. That was a disaster as well. The SNS was cumbersome and would draw out feedings much longer than they needed to be. Most of the time, the tube would pop out or our LOs latch wouldn't grab the tube well. At one point it took us (together) 45 minutes for her to drink 1 oz. In addition, the formula was burning mom's nipples. This lasted about a week. After a particularly frustrating day of bleeding nipples and severe pain, we called the LC and asked if taking a break from BFing would totally ruin our chances of being successful. It was Friday and we were going in on Monday to see a different LC, so the she said taking a break over the weekend was fine. We finger fed her with the SNS that weekend. That Sunday was the first and last time mom felt engorged BTW. We also picked up the pump I mentioned earlier and started using it, but it didn't produce much of anything...hence the engorgement.

Once again, we were told the latch was fine, even though there was still some pain (it was much better than before, though). We were also told about Fenugreek for the first time, and we picked some up after the appt. To make a long story short(er), we've been supplementing (first with finger fed SNS, then to paced bottle feeds, and now to non-paced slow flow nipples). We've had some ups and downs in the formula intake dept, but now we are essentially at supplementing about 20 mls a feeding until the last two for the night when we supplement more to help put her down for the night. She takes no more than 240 ml (8 oz.) a day of formula and we are still slowly decreasing that number.

One other important point to note is that we thought we were doing great with the supplement reduction (down to 180 ml a day) by only really supplementing the last 2-3 feeds. She started STTN at about 2.5 months which also cut down a lot, as the midnight feed was always formula or pumped milk (when we had enough). Then we noticed a severe reduction in weight (2 lbs in 2 weeks), albeit with a rather inaccurate bathroom scale. With that scare we upped her formula again (back to 240 ml) and scheduled a LC appt. The LC, though we love her dearly for not being coy with us as to what needs to be done, gave us some conflicting comments. First she said that the loss in weight was likely due to her settling into a more "proper" weight to height ratio (I'm 5'7" and mom is 5'2", so she isn't a very long baby, though she was fairly heavy). But when we informed her that she was STTN, she became concerned that she wasn't feeding often enough. We actually had her down to 6 feeds a day (again, this is at 2.5-3 months). She told us to get back up to 8 feeds a day if we could and we are trying.

A typical day of feeding today goes something like this: first feed in the morning when she wakes up (anywhere between 5:00-7:00) gets no supplement. Mom has been sitting on her supply for over 6 hours at that point as the last feed of the night is always 9:30pm. From there, we basically feed on demand every 2-3 hours until the last two feeds, which we schedule at 7:30 and 9:30. We give 50 ml supp. at the 7:30 and 90 ml at the 9:30. These two feedings are being slowly reduced by 10 ml over a few days to reduce her dependence on supplementation.

Final note. Every time we went to the LC, they did a before and after to check how much she was getting at the breast. Until her 2 month checkup, she never got more than ~10 ml from a 20 minute feed at the office. At her 2 mo. she got 18 ml, which was decent considering she just had her shots. We just went in last Friday and were told she got just over an ounce (again with a 20 minute feed). All of this was fairly discouraging to mom, but I try to keep her spirits up. I know she wants to continue BFing and I'm on board with whatever she chooses. I'm now trying to see if we can rent a hospital grade pump and a precision scale for before and after readings to do at home. According to a paper I received a few weeks ago from our hospital it might be free as of the first of this month!

Re: Nothing at the pump

Thanks for writing the novel. It really changes the picture. I started with the assumption that all was basically well and that mom was doing some probably unnecessary pumping, since that's a much more common scenario.

I think that renting a hospital-grade pump and professional scale is an excellent plan of action. With the pump, mom can hopefully really increase her supply, supplement with breastmilk rather than formula, and make weaning from those supplemental bottles that much easier. When I used a hospital-grade pump, I noticed an immediate and significant difference in output over what I was getting when using an Ameda Purely Yours. The scale will enable you to know when you must supplement and when you don't need to, and will allow you to keep better track of your LO's weight.

Your LC gave you good advice about number of feedings. 6 nursing sessions per day isn't enough for a baby who isn't nursing well. Most babies need at least 8 nursing sessions per day, and many require 10-12. If your baby had dropped into a different percentile while maintaining frequent feedings, it would have been much less concerning (which I think exlains the LC's advice).

Questions:
- Has baby been checked very carefully for tongue tie?
- Has mom been checked for physical causes of low supply (PCOS, thyroid problems, retained placenta)?
- Has mom ever had any type of breast surgery or injury?

Re: Nothing at the pump

Thanks for the response. As I finished writing that up, I started to see where the LC was coming from. Our LO has been checked for tongue tie, and mom hasn't had any surgery (it was a VB BTW). I don't think she's been checked for those others, though.

We've got her up to 8 feedings a day again, but since she STTN they essentially have to be every 2 hours. The first feeding goes really well. She latches on for a while and it is VERY clear she is drinking a lot (lot's of audible swallowing). About 2 feedings later, though, she starts to unlatch very quickly, frustrated. Just as I began to write this, mom was struggling to keep her at the breast for more than a couple minutes. As always, with this time of day, we supplement with 20 ml of formula and mom pumps or expresses (pumps this time). Our LO first acts fussy when the formula finishes, but usually calms down by the time I get her over to the diaper changing table. And, as with every single feeding, mom gets milk that can be measured in drops.

I'm curious if going the entire night without feeding, pumping, or expressing usually results in engorgement for mother's that BF normally. Like I mentioned in the OP, mom has only ever felt engorged once, and that was after sitting on her supply for over 2 days. Could she be producing milk at a slower rate than what she should be, resulting in the feedings later in the day (spaced by about 2 hours) being so quick?

Re: Nothing at the pump

Every 2 hours is a very normal feeding frequency. Many breastfed babies eat every 90 minutes, or even more frequently. So moving to 8 feedings a day is a step in the right direction! I'd suggest cramming in some additional feedings in the middle of the night- even just one sleepy nursing session right before mom goes to bed can make a big impact in terms of the number of calories baby gets from breastmilk.

Going an entire night without nursing, pumping, or expressing may or may not result in engorgement, depending on the particular mom and on how long the baby has been sleeping through. The first few times a baby sleeps through, it's common for a mom to experience engorgement, and that engorgement/fullness may last for some time depending on how responsive the mom's supply is to the baby's demand (or lack thereof). After a baby has been sleeping though for a while, it's normal for nighttime supply to reduce a lot. The body's internal milk-making clock is quite sensitive and trainable.

It's very common for milk supply to peak in the wee hours of the morning. Women naturally make more prolactin (the milk-making hormone) at night, which often means that the first a.m. feeding is a big one. As the day goes on, prolactin levels decline and milk supply tends to drop- which is why moms who must supplement typically find that they must do so later in the day.

One more question: birth control. What are you using? Hormonal contraception can have a negative impact on supply, and this includes supposedly safe for breastfeeding methods like the mini-pill and Mirena IUD.

Re: Nothing at the pump

This is all making a lot more sense. It's good to hear that there are very understandable reasons for what we've been going through. I'm not sure if mom is ready to give up her uninterrupted sleep for the time being. She seems terrified that our LO will keep her up much longer than the feeding would take (she tends to take at least 30 minutes to fall asleep after waking up for a feeding, and she doesn't nap well so mom doesn't have many chances for sleep during the day).

As for birth control, we don't use any, as there is no need at the moment.

Off topic: how old is your big girl? Sounds like she's on her way to discovering relativity for herself .

Re: Nothing at the pump

The big gal is 6, and already much smarter than I am. Sigh.

Okay, no birth control is good unless it's not. A lot of new parents go through a huge sexual dry spell after the arrival of a new baby, particularly if there are problems (like nursing issues). However, if you're having sex, use some form of birth control unless you're okay with having another baby very soon. A lot of people think "oh, she's breastfeeding, that means we can't get pregnant" which is not true, particularly if the mom is not following ecological breastfeeding guidelines (which include no supplements, bottles, or sleeping through the night). Your wife may want to consider taking a home test if there's any possibility of pregnancy, because pregnancy is a possible explanation for low supply.

I can totally understand why mom doesn't want to give up uninterrupted sleep. But I still really think that cramming in even one more feeding is a really good idea when trying to increase milk supply. When there's a supply issue, you want to nurse your baby (or the pump) like a newborn, which means around the clock. The longer prolactin levels stay very high, the more milk a woman will make.

Re: Nothing at the pump

Those night nursing sessions are extremely important to build and maintain supply long-term. I have seen that be an issue for several mothers, both here and IRL. Normally by 3 months, moms are past that and can let baby STTN if baby is doing so and it will be OK, but it sounds like It might be something that could be helpful in your situation.

Yes, not STTN stinks (I haven't had a full night's sleep since I was pregnant with my fist baby) but its part of parenthood. Friends of grown children tell me that they still wake up wondering about their kids!